Outcome of Local Excision of Rectal Carcinoma

This study was designed to determine the results of patients with rectal adenocarcinoma treated with local excision.

A retrospective, chart review was conducted for all patients treated with local excision for rectal adenocarcinoma from 1984 to 1998.

Sixty-four patients were retained for analysis. The median follow-up was 37 (range, 9–125) months. There were 15 local failures with a median time to local failure of 12 months. Seven patients were salvaged with further operation (4 by repeat local excision, 4 by abdominoperineal resection, and 1 by low anterior resection). The incidence of local recurrence increased with advancing stage of the carcinoma (T₁, 13 percent; T₂, 24 percent; T₃, 71 percent), histologic grade of differentiation, (well, 12 percent; moderately, 24 percent; poorly, 44 percent), and margin status (negative, 16 percent; close (within 2 mm), 33 percent; positive, 50 percent). Sixteen percent of carcinomas ≤ 3 cm failed compared with 47 percent for carcinomas > 3 cm. Nine percent (1/11) of T₂ patients treated with adjuvant radiation therapy recurred locally compared with 36 percent (5/14) without radiation therapy. Three of four T₃ patients who received radiation therapy failed locally compared with two of three who did not. Using the Kaplan-Meier method, the overall survival at five years was 71 percent, and disease-free survival was 83 percent. Actuarial local failure was 27 percent and freedom from distant metastasis was 86 percent. The sphincter preservation rate was 90 percent at five years.

Local excision alone is an acceptable option for well-differentiated, T₁ carcinomas, ≤ 3 cm. Adjuvant radiation is recommended for T₂ lesions. The high local recurrence rate in patients after local excision of T₃ lesions with or without adjuvant radiotherapy would mandate a radical resection.